| NPI | 1417117508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35.130469) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 237612) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2018-03-17 |